Quote from menardca
I would like to get some advice about a patient i had yesterday. My first shift off of orientation was kinda crazy. My patient had a PEG tube, Rectal tube, stoma with a PEG in it to administer vanc and a triple lumen cath. Everything was going well until about 4pm. Then I had a order for a mag rider and potassium 60 meq over 6 hours. The K would start at 4pm. At 6pm there was an order for Zosyn iv and the vanco through the ostomy tube. There was iv nutrition also running all day.
I ended up leaving a lot of work for the night shift which I am still beating myself up over. I really didn't want to do that. So I am trying to see what I could do better.
Could I have run the Potassium and Magnesium at the same time? I ran them one after another. Which put everything was behind. Could I have ran the Zosyn at the same time. I ended up leaving the zosyn and vanc for the next shift as well as 3 K. I am know it's a learning process so an advice would be helpful.
I would have call the pharmacy for help but I had 4 other patients that all started having there own problems at about 4pm also. So I didn't have the time.
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You have a multi-lumen. You have TPN(IV nutrition) in one port......You could have put the potassium in another port and piggy backed the MgSO4 into the Potassium and hung Zosyn IV on the third and given the vanco through the PEG......utilizing all three ports.
What department are you in? Are you in ICU with 5 patients? or Are you on a step down? I am hoping a step down. Five patients for ICU is too many. If you could only run 20meq's of potassium every two hours I am wondering if you are on a general floor. You have been a RN for about 3 years right? Are you new to this acuity of patient?
I know it is over whelming.
Five sick patients is a lot for anyone. But, a court of law really isn't concerned about your other patients....unfortunately......it is up to you to figure out how to prioritize and do it all for all of your patients. Calling pharmacy is using your resources to help you organize your time and optimizing the treatment for the patient. You could have also asked your preceptor, your charge nurse or a trusted peer. Utilizing your resources .....knowing when to ask for help........is just as important as knowing what to do.
In this instance you could have even IV piggybacked the Zosyn into the Potassium. But you have three lumens. Potassium and MGSO4 in one. Zosyn in the other. TPN third. Technically they are all compatable and all three can be give in one port on their pown pumps. Does this make sense?
I wish you the best.